I can see the status bar

Chapter 1074 Problem Solving (Blood Donation Plus Series 057)

This chapter is added to thank the book friend "Yuecheng i" for donating 2020ml of whole blood on October 10, 17.

The dead are like husbands, never giving up day and night.Things in the world change too fast, and we can't always look at the passing time that has gone away like a river.Humans are creatures who live in the present, we can't change the past, and we can rarely foresee the future.The only thing that can be grasped by people is the present.

Sun Lien and the doctors in the treatment group are actively intervening with the patients according to the actual situation.

A total of more than 20 qualified psychologists were mobilized from Yunhe, and two of them were assigned to work in Yunhe City Infectious Disease Hospital.Two psychiatrists have to provide psychological support to more than 500 diagnosed patients and four to five hundred medical staff... This is a difficult task that must be grasped and carried out as soon as possible.

The human mind is a very strange thing.It often has nothing to do with appearance, and it has little to do with people's experience.People who seem strong may be psychologically fragmented and almost on the verge of collapse.The person who seemed terrified, as if he had been swallowed by fear, was able to adjust his mental state and continue to support himself to go on.

Before the psychiatrist starts his work, he must first find a way to distinguish which of these patients needs intervention and who can carry it by himself.Therefore, after the two psychologists arrived at Yunhe Infectious Disease Hospital, the first thing to do was to conduct a general visit and classification of patients in each ward.Those patients who are obviously emotionally broken and need help are singled out, and then follow-up intervention can be carried out.

Sun Li'en didn't meet these psychologists at all, he was busy directing the rescue in the ward - the aunt in ICU 11 bed suddenly became ill today.The status bar indicates that the old lady has hyperkalemia and hypocalcemia, and conventional drug interventions have been taken, but her condition is still very bad.

The ECMO team led by Dr. Jiang is already in place, but if the old lady’s potassium blood intervention has no effect, even ECMO is useless—even if the VA ECMO mode can replace part of the heart and all lung functions, but if hyperkalemia It cannot be reversed. Once a malignant arrhythmia or ventricular fibrillation is triggered, ECMO cannot bypass the beating heart and replace all heart functions.

She needs to be on ECMO, but only after the electrolyte balance in the body.

What Sun Li'en is commanding now is such a rescue.

"Adrenaline 1, 10 sugar 250, insulin 20." Sun Li'en, who directed the rescue in the ICU, spoke very fast, and three doctors and four nurses were busy with therapeutic intervention under his command, "Slow push 25 Calcium gluconate plus an equivalent amount of [-] sugar..."

During rescue, in order to shorten the time for issuing some instructions, doctors often "reduce" the content of treatment to a certain extent, such as changing the intravenous injection to "go", and directly shortening the concentration of 20.00% or [-]% to "Ten sugars" or "two five sugars", and intravenous injection becomes "slow push".

This kind of password varies from hospital to department or even from department to department, but the abbreviations are still the same—in order to save time for treating patients, try to be as fast as possible, and then be as fast as possible.

The old lady surnamed Lu's blood potassium has reached 6.41mmol/L, and there seems to be signs of further increase.Sun Lien is now concentrating all his energy on monitoring her vital signs and reducing blood potassium as soon as possible. He really has no time to figure out what is the reason for the increase in Madam Lu's blood potassium.So, while issuing the rescue command, Sun Lien shouted to Yuan Pingan, "Find out the cause of her hyperkalemia!"

"Now it's clear that it's useless!" Yuan Ping'an objected to Sun Lien's clinical opinion for the first time, and he and two other nurses rushed over pushing the dialysis machine, "Go to dialysis first, and then we'll talk about getting blood potassium down! "

Sun Li'en stepped aside, and then continued to stare at the long status bar above Mrs. Lu's head, trying to find the culprit that caused her hyperkalemia as soon as possible.

The rescue intervention has been carried out for half an hour, and it was Yuan Ping'an who directed the medical team members to intervene in the first 10 minutes.Half an hour ago, Mrs. Lu's heart rate changed irregularly, which triggered an alarm from the monitor.After Yuan Ping'an arrived at the scene, he quickly directed the nurse to sample the patient's arterial blood.The analysis indicated that Mrs. Lu's serum potassium was as high as 6.17mmol/L, which belonged to severe hyperkalemia.

Hyperkalemia is a relatively common problem in the ICU.The coping methods are relatively mature. Calcium antagonizes the arrhythmia caused by hyperkalemia in the myocardium. The mixed action of glucose and insulin promotes the flow of potassium into the cells, and diuretics are added to promote potassium excretion.These means are routine application of anti-hyperkalemia program.

But this time, Yuan Ping'an's plans seemed a bit unwieldy in Yuan Pingan's hands.

The calcium supplement made Mrs. Lu's heartbeat a little bit better.But that's just a little bit better.When Sun Lien arrived at the scene, he found through the status bar that during the 10 minutes, under the intervention of Yuan Ping'an, Mrs. Lu's blood potassium not only did not decrease, but even increased by 0.24mmol/L.

Sun Lien checked again, and first ruled out the possibility that Yuan Pingan made a major mistake and did not stop the infusion of potassium-containing drugs when rescuing patients with hyperkalemia.Then, he replaced Yuan Pingan, who was already a little nervous, and started the treatment again.

Sun Li'en didn't have the time to review Yuan Ping'an's treatment plan again.He can only think from his own experience that it is impossible for Yuan Pingan to get the treatment for hyperkalemia wrong.But if Yuan Ping'an is not mistaken... that means that the rescue measures he is doing now have already been carried out by Yuan Ping'an.

The patient did not respond well to conventional hypokalemic therapy, and the serum potassium level was still rising rapidly.Sun Li'en frowned, looking at the dialysis machine that Yuan Ping'an rushed to install.In fact, Yuan Ping'an's judgment cannot be wrong. Now, lowering blood potassium is the most critical treatment content.But on the other hand, if the cause of the rapid increase in the patient's blood potassium is not found, symptomatic treatment can only delay time.Without the correct diagnosis, there can be no correct treatment.

Now dialysis can quickly reduce the blood potassium level in the patient, but this does not mean that you can always rely on dialysis to fight against hyperkalemia - long-term dialysis, even with CRRT, may lead to electrolyte imbalance in the patient's body out of balance.It must be supplemented while treating.Without finding the reason for the rapid increase in blood potassium, there is no way to determine the speed of potassium supplementation for Mrs. Lu.This will greatly hinder the subsequent treatment.

It may be safer to do plasma exchange, but plasma exchange will reduce the level of specific immune antibodies in her body, which is not very high, and she still has the new coronavirus in her body!
There were so many prompts on the status bar that Sun Lien searched for at least 3 minutes but still couldn't see the head.Judging from the prompts given in the status column, Mrs. Lu is currently suffering from severe hypoxemia, insufficient organ tissue perfusion, and metabolic acidosis.But now Sun Lien cannot use sodium bicarbonate to treat metabolic acidosis—in order to deal with hyperkalemia, both he and Yuan Pingan ordered the use of calcium gluconate for the elderly.Calcium gluconate cannot be used in combination with drugs containing bicarbonate, otherwise a chemical reaction may occur that may lead to calcium carbonate precipitation. At the same time, sodium bicarbonate reacts with calcium gluconate, which may produce carbon dioxide and cause air embolism.

Metabolic acidosis cannot be resolved at present, but sodium bicarbonate can still be used after a period of dialysis to determine the blood potassium level.

As long as the source of hyperkalemia is found, other problems can be easily solved.

Sun Lien's eyes suddenly brightened, and he turned forward to the second and third status reminders of Mrs. Lu.

"Hepatitis B 70180.34.59", "cirrhosis 18121.44.07".

Mrs. Lu has hepatitis B as her basic disease, and her hepatitis has developed to a serious level.Liver cirrhosis lasted at least two years.

This hyperkalemia...could it be related to hepatitis?
　Chapter No.16 is temporarily unavailable for some reason, and it will be seen again after Monday.

　　
　
(End of this chapter)